Diagnostic Accuracy of AI for Opportunistic Screening of Abdominal Aortic Aneurysm in CT: A Systematic Review and Narrative Synthesis.

In this review, we focused on the applicability of artificial intelligence (AI) for opportunistic abdominal aortic aneurysm (AAA) detection in computed tomography (CT). We used the academic search system PubMed as the primary source for the literature search and Google Scholar as a supplementary source of evidence. We searched through 2 February 2022. All studies on automated AAA detection or segmentation in noncontrast abdominal CT were included. For bias assessment, we developed and used an adapted version of the QUADAS-2 checklist. We included eight studies with 355 cases, of which 273 (77%) contained AAA. The highest risk of bias and level of applicability concerns were observed for the "patient selection" domain, due to the 100% pathology rate in the majority (75%) of the studies. The mean sensitivity value was 95% (95% CI 100-87%), the mean specificity value was 96.6% (95% CI 100-75.7%), and the mean accuracy value was 95.2% (95% CI 100-54.5%). Half of the included studies performed diagnostic accuracy estimation, with only one study having data on all diagnostic accuracy metrics. Therefore, we conducted a narrative synthesis. Our findings indicate high study heterogeneity, requiring further research with balanced noncontrast CT datasets and adherence to reporting standards in order to validate the high sensitivity value obtained.

Four years' experience of teleconsultations in daily clinical practice.

In the four-year period from 2000, the Department of Informatics and Telemedicine of the Donetsk R&D Institute of Traumatology and Orthopaedics organized 210 teleconsultations. In 91 cases the Institute was the enquiring party and in 119 the consulting one. Teleconsultations were carried out for 137 male and 73 female patients aged between one month and 85 years. A review of the results showed that the reliability of diagnosis of different traumas and diseases made using digital images was 88%. The efficiency of implementing the recommendations provided by remote consultants was 88%. We developed an algorithm to select the most suitable telemedical technique for a clinical situation. We also developed a list of indications for clinical teleconsultation. The optimum equipment for clinical teleconsultations consists of a PC, digital camera, dial-up Internet line and printer. Asynchronous formal and informal Internet-based teleconsultations are most expedient for routine clinical practice, supplemented by realtime teleconsultations where necessary.

Our experience with telemedicine in traumatology and orthopedics.

BACKGROUND: Telemedicine widely takes root in all branches of modern medicine including traumatology and orthopedics. The main goal of this work was to present our experience with asynchronic teleconsultation in daily clinical practice, in particular in the treatment of polytrauma patients. METHODS: Throughout 2000 and 2003, we carried out 144 teleconsultations for 92 men and 52 women (age range three months to 80 years). Of these, we were the inquiring party in 51 cases, the consulting one in 88 cases, and the mediator in five cases. Time passed till the completion of consultations ranged from 12 to 24 hours. RESULTS: The number of consultants was one, two, three, and more in 99, 22, 3, and 15 teleconsultations, respectively. The most common questions (n=128) were those of treatment tactics. In the majority of cases, the consultant approved of the diagnosis suggested by the inquirer and formulated or corrected the scheme of the treatment. The majority of teleconsultations were concerned with various problems of traumatology (n=83) and orthopedics (n=31). For each clinical case, we received a mean of 2.6 replies (range 1 to 8). The effectiveness of the suggested treatment methods accounted for approximately 80% in final decision making. Teleconsultations provided considerable benefits in the treatment of polytrauma patients, including decreases in in-hospital treatment necessities (16%), in complication rates (9.2%) and their severity, the relative risk of developing complications (10%), and in the need for re-hospitalization (0.4%). CONCLUSION: In view of our experience, we recommend that asynchronic consultations on the basis of the Internet-technology be more commonly used in the treatment of polytrauma patients.